High Rate of Gastrointestinal Bleeding in Patients with Secondary Sclerosing Cholangitis in Critically Ill Patients (SC-CIP)

Abstract

Secondary sclerosing cholangitis in critically ill patients (SC-CIP) is a rare cholestatic liver disease triggered by long-term intensive care treatment. The aim of this study was to evaluate the frequency and characteristics of gastrointestinal bleeding in SC-CIP. Patients with diagnosed SC-CIP were retrospectively identified and compared to a control group of patients with cardiac surgery and intensive care treatment but without the development of SC-CIP. Fifty-three patients with SC-CIP and 19 controls were included in the study. The frequency of gastrointestinal bleeding was 30% in SC-CIP (16 patients) and 5% in the control group (1 patient) (p = 0.03). Bleeding occured in the mean 13 months after admission to an intensive care unit in SC-CIP, three patients (19%) suffered bleeding during intensive care treatment. Three SC-CIP patients (19%) had cirrhosis at the time of bleeding, five (31%) had splenomegaly, and four (25%) received oral anticoagulation. In SC-CIP, 13 bleedings were identified in the upper gastrointestinal tract, two in the lower, and one remained unknown. The most common reasons for bleeding were gastroduodenal ulcers. In total, 80% of patients needed blood units, and one death due to bleeding occurred in SC-CIP. In conclusion, gastrointestinal bleeding is a frequent complication in patients with SC-CIP. Whether the liver disease itself or cofactors cause the susceptibility for bleeding remains unclear.

Endoscopic Therapy for Pouch Leaks and Strictures: A Systematic Review

“…1 Future effort could consider drug-eluting balloons, or biodegradable or drug-eluting stents. 37 As endoscopic stenting has not been well studied in patients with ileal pouches, it is not routinely recommended for such patients. 37…”

“…1 Primary sclerosing cholangitis is associated with portal hypertension, thrombocytopenia, and coagulopathy and, hence, may present an increased risk for bleeding. 37 Therefore, the risks and benefits of the intervention must be considered in a case-by-case scenario.…”

“…37 As endoscopic stenting has not been well studied in patients with ileal pouches, it is not routinely recommended for such patients. 37…”